BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 484|
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UNFINISHED BUSINESS
Bill No: SB 484
Author: Beall (D), et al.
Amended: 9/3/15
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 5-0, 4/21/15
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE HEALTH COMMITTEE: 9-0, 4/29/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SENATE FLOOR: 40-0, 6/3/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Runner,
Stone, Vidak, Wieckowski, Wolk
ASSEMBLY FLOOR: 79-0, 9/8/15 - See last page for vote
SUBJECT: Juveniles
SOURCE: National Center for Youth Law
DIGEST: The bill requires California Department of Social
Services (CDSS) to establish a methodology for identifying
group homes that have levels of psychotropic dug utilization
warranting additional review, and to inspect identified
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facilities at least once a year, as specified. Additionally,
this bill permits CDSS to share information and observations
with the facility and to require the facility to submit a plan
within 30 days to address identified risks, as specified.
Assembly Amendments add licensing provisions stating that
psychotropic medications shall only be used in accordance with
the written directions of the prescribing physician and as
authorized by the juvenile court. Amendments further add
licensing provisions requiring facilities to maintain specified
information in the child's records regarding psychotropic
medication. Additionally, amendments narrow the scope of the
information and measurements required to be considered in
establishing the methodology for identifying group homes and
strikes specified components to be included in a corrective plan
submitted by a facility. Further, amendments strike specific
components to be determined by CDSS in monitoring of the
facilities implementation of the plan.
ANALYSIS:
Existing law:
1)Establishes the Community Care Facilities Act, which provides
for the licensure and regulation of community care facilities,
including group homes, by CDSS, and requires that licensed
facilities be subject to unannounced inspections under
specified circumstances. (HSC 1500 et seq, and 1534)
2)Requires CDSS to establish a rate classification level (RCL)
structure for group homes with a corresponding rate structure
according to the level of care and services that will be
provided, as specified. (WIC 11462)
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3)Permits a group home to be classified as an RCL 13 or 14 if
the program only accepts children with special treatment needs
and meets other requirements. Additionally, requires the
California Department of Health Care Services (DHCS) to
annually certify group homes seeking classification as RCL 13
or 14 and permits such facilities to accept minor dependents
who are seriously or emotionally disturbed if certain
conditions are met. (WIC 11469, WIC 4096.5 and HSC 1502.4)
4)Requires CDSS to publish and make available to interested
persons a list or lists covering all licensed community care
facilities, other than foster family homes and certified
family homes, to include specified information regarding group
homes, transitional housing placement providers, community
treatment facilities or runaway and homeless youth shelters
including complaints, citations, fines and the number of law
enforcement contacts made by group homes. (HSC 1536)
This bill:
1) Requires CDSS to compile, to the extent feasible and based
on information provided by the California Department of
Health Care Services (DHCS), specified child welfare
psychotropic medication measures developed by CDSS and
specified Healthcare Effectiveness Data and Information Set
(HEDIS) measures related to psychotropic medication,
pertaining to each group home, in order to review and
evaluate the use of psychotropic medication in group homes.
2) Requires CDSS to establish a methodology for identifying
group homes that have levels of psychotropic dug utilization
warranting additional review, in consultation with DHCS.
3) Requires CDSS to inspect a facility identified as
appearing to have levels of psychotropic medication
utilization warranting additional review at least once a
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year, and requires the inspection to include, but not be
limited to, a review of the facilities plan of operation,
child-to-staff rations, staff qualifications and training,
implementation of children's needs and services plan,
confidential interviews of residents, and availability of
psychosocial and other alternative treatment to the use of
psychotropic medication.
4) Permits CDSS to include confidential discussions with
former residents, and confidential discussions with
physicians prescribing medications to residents.
5) Permits CDSS to do either or both of the following after
an inspection:
a) Share relevant information and observations with
county placing agencies, social workers and probation
officers, the court, dependency counsel, or the Medical
Board of California.
b) Share relevant information and observations with the
facility and require the facility to submit a plan,
within 30 days, to address any identified risks within
the control of the facility. Requires CDSS to approve and
monitor implementation of the plan.
6) Provides that psychotropic medications shall only be used
in accordance with the written directions of the prescribing
physician and as authorized by the juvenile court.
7) Requires facilities to maintain specified information in
the child's records regarding psychotropic medication
including a copy of any court order authorizing psychotropic
medications and a separate log for each medication, as
specified.
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8) Permits CDSS to implement this bill through all-county
letters or similar instructions until regulations are filed
and requires emergency regulations to be adopted on or
before January 1, 2017 and final regulations to be adopted
on or before January 1, 2018.
9) Requires CDSS to monitor the facility's implementation of
the plan to determine whether the facility has reduced the
rate that psychotropic medications are administered, and the
percentage decrease; whether and to what extent alternative
less invasive treatments are being provided to residents,
and the percentage increase; whether and to what extent
10) Requires CDSS and DHCS in consultation with specified
stakeholders to develop additional performance standards and
outcome measures that require group homes to implement
programs and services to reduce the utilization of
psychotropic medications in group homes, including
behavioral management programs, emergency intervention
plans, and conflict resolution processes.
11) Requires CDSS to post on its internet website a statewide
summary of information gathered pursuant to this bill and
requires such information be de-identified and aggregate,
and does not violate the confidentiality of a child's
identity and records.
Background
Group Homes. Group homes are 24-hour residential facilities
licensed by CDSS to provide board and care to foster youth from
both the dependency and delinquency jurisdictions. Group home
facilities are organized under a system of rate classification
levels (RCLs) ranging from 1-14 that are based on levels of
professional training and adult-to-child ratios. In practice,
the majority of group homes are at or above RCL 10 with nearly
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50 percent of group homes at RCL 12. There is wide variation in
group home size from as few as six children to more than 100.
Group Home Program Statement. Group homes are required to
establish a "group home program statement" that includes a
training plan that is appropriate for the client population and
the training needs and skill level of child care staff. Through
regulation, existing law provides that newly hired staff
complete at least 24 hours of training within 90 days of being
hired, and 40 hours within 12 months, as specified, with all
existing staff receiving 20 hours annually. Regulations provide
for the minimum topics that must be included (e.g. discipline
policies and procedures, behavior problems / psychological
disorders, and mental health / behavioral interventions). Social
work staff is required to establish a "needs and services plan"
for each child that identifies the specific needs of an
individual child, and delineates those services necessary in
order to meet the child's identified needs.
Group homes are required to submit to the department an
emergency intervention plan, identifying how the facility will
use emergency interventions to address aggressive or assaultive
behavior of residents. The plan is required to be designed by
the licensee and a qualified behavior management consultant and
must be appropriate for the client population served by the
group home, and for the staff qualifications and staff emergency
intervention training.
Psychotropic Medication Use in Children. Concern over the use of
psychotropic medications among children has been well-documented
in research journals and the mainstream media for more than a
decade. The category of psychotropic medication is fairly broad,
intending to treat symptoms of conditions ranging from ADHD to
childhood schizophrenia. Some of the drugs used to treat these
conditions are FDA-approved, including stimulants like Ritalin
for ADHD, however only about 31 percent of psychotropic
medications have been approved by the U.S. Food and Drug
Administration (FDA) for use in children or adolescents. It is
estimated that more than 75 percent of the prescriptions written
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for psychiatric illness in this population are "off label" in
usage, meaning they have not been approved by the FDA for the
prescribed use, though the practice is legal and common across
all manner of pharmaceuticals.
Anti-psychotic medications, used to treat more severe mental
health conditions, include powerful brand-name drugs such as
Haldol, Risperdal, Abilify, Seroquel and Zyprexa. They have very
limited approval by the FDA for pediatric use beyond rare and
severe conduct problems that are resistant to other forms of
treatment, such as Tourette's syndrome, behavioral symptoms
associated with autistic disorder, childhood schizophrenia, and
bipolar disorder. However, the off-label use of these
anti-psychotics among children is high, particularly among
foster children. According to a study published in 2011,
children who took antipsychotic medications were likely to
suffer ill health effects including "cardiometabolic and
endocrine side-effects" as well as significant weight gain. The
authors recommended that collaboration between child and
adolescent psychiatrists, general practitioners and
pediatricians is essential to "reduce the likelihood of
premature cardiovascular morbidity and mortality."
Compounding the potential for unintended side effects is the use
of combinations of psychotropic medications, which foster youth
are particularly likely to be prescribed, despite limited
evidence of clinical efficacy.
Prescribing rates in California. A recent series of stories
published in the San Jose Mercury News detailed significant
challenges in accessing pharmacy benefits claims data held by
the DHCS, and demonstrated that prescribing rates were far
higher than had been anticipated by child welfare system
experts. Specifically, the data revealed that nearly 1 in 4
youth, and 56 percent of all youth residing in group homes were
prescribed at least one psychotropic medication. Furthermore,
for those youth prescribed psychotropic medications, nearly 60
percent were prescribed an anti-psychotic - the powerful drug
class most associated with debilitating side effects, and 36
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percent were prescribed multiple medications, also referred to
as "polypharmacy."
Increases observed in California mirror those across the nation
- children in foster care represent only three percent of
children covered by Medicaid, yet, a study of pharmacy claims in
16 states showed that foster children enrolled in Medicaid were
prescribed antipsychotic medications at nearly nine times the
rate of other children receiving Medicaid.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
The Assembly Appropriations Committee states this bill may incur
ongoing costs in the range of $300,000 to $600,000 (GF) per year
to CDSS to conduct annual site visits at group homes identified
as having disproportionately high and inappropriate levels of
psychotropic medication use by foster youth. Additionally, the
analysis estimates one-time costs of approximately $250,000 (GF)
to CDSS to compile information on group homes, consult with
stakeholders, and develop a methodology to identify group homes
for additional scrutiny and ongoing costs of $130,000 ($65,000
GF) to DHCS to identify, evaluate and collate claims data
packages to be used for the purposes of this bill.
SUPPORT: (Verified 9/8/15)
Advokids
Alameda County Foster Youth Alliance
All Saints Foster Care Project
California Court Appointed Special Advocates
California Department of Justice
California Youth Connection
Children's Advocacy Institute
Children's Defense Fund - California
Children's Law Center of California
Children's Partnership
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Consumer Watchdog
Dependency Legal Group of San Diego
East Bay Children's Law Offices
East Bay Community Law Center
First Focus Campaign for Children
First Place for Youth
Humboldt County Transition Age You Collaboration
Legal Advocates for Children and Youth
Legal Services for Prisoners with Children
Mockingbird Society
National Association of Social Workers
National Center for Youth Law
Peers Envisioning and Engaging in Recovery Services
Public Counsel's Children's Rights Project
Santa Clara Board of Supervisors
Youth Law Center
10 individuals
OPPOSITION: (Verified9/8/15)
None received
ASSEMBLY FLOOR: 79-0, 9/08/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,
Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Chávez
Prepared by:Sara Rogers / HUMAN S. / (916) 651-1524
9/8/15 19:24:28
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